Describe the metabolic events that led to Rachel's symptoms and subsequent admission to the ED (polyuria, polydipsia, polyphagia, fatigue, and weight loss), integrating the pathophysiology of T1DM into your discussion

Question

What will be an ideal response?

Answer 1

With inadequate insulin levels present in her system, glucose is unable to get into her cells that require insulin for the translocation of GLUT-4 transporters. As a result, her body has been attempting to filter the excess glucose from the blood via the kidneys, which has resulted in glycosuria and polyuria. The fluid loss from excess urination then triggered her thirst mechanism, causing polydipsia. Without fuel, her cells are releasing signals that they're starving, which stimulate gluconeogenesis in the liver (which further exacerbates her hyperglycemia) and leads to excessive hunger, or polyphagia. Other effects of the absence of insulin include the lack of signals to the body to increase storage of nutrients and an increase in catabolic hormones, leading to lipolysis and production of ketones as fuel. This contributes to her weight loss as fat stores are utilized, muscle is catabolized, and fluid weight is lost. Fatigue is a factor for several reasons, including the lack of fuel the cells can access, decreased energy stores, the stress placed on the body to try to clear the excess glucose from the blood, dehydration from fluid loss, electrolyte imbalances, and metabolic acidosis from elevated levels of ketones in her system.